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2014 Annual Inspection Form - DRAFT Pass Fail Pass Fail Pass Fail Pass Fail Interstitial Monitoring Pass Fail Pass Fail Pass Fail Pass Fail UST-01 Rev Date: 08/24/20 Dispenser Area

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  • Underground Oil Storage Tanks

    Annual Inspection Report

    Rev 8/24/2020

    General Instructions

    1. State law and Department of Environmental Protection (Department) rules require submittal of an inspection

    certifying all procedures and equipment are in compliance. The Department does not accept failing annual


    Exceptions : Inspection failures for (1) Certified A/B Operator can be resolved by the owner by submitting a

    copy of a current and valid certificate; (2) Inadequate daily inventory can be resolved by the owner submitting

    current, reconciled daily inventory; (3) Inadequate SIR Report can be reloved by the owner submitting a

    passing SIR report; and (4) Failing cathodic protection (CP) results can be resolved by an installer or CP

    certified inspector retesting CP and attaining passing results within six months.

    2. A facility that fails to submit a passing annual inspection may be prohibited from receiving deliveries and

    dispensing product in accordance with Maine law 38 M.R.S. § 565-A. Items that are failing must be repaired or

    corrected within thirty (30) days or the owner must notify the Department.

    3. Leak detection equipment and procedures, spill and overfill prevention devices must be checked or tested

    annually for proper operation. Cathodically protected tanks and piping must be checked annually to insure they

    are adequately protected from corrosion.

    4. All work associated with testing of equipment and checking of procedures must be performed by or under the

    direct, onsite supervision of a Maine certified underground storage tank installer or a Maine certified

    underground storage tank inspector.

    5. Mail completed reports to: Annual Tank Inspections, Maine Department of Environmental Protection, 17 State

    House Station, Augusta, Maine 04333-0017 (physical address: 28 Tyson Drive, 04330) within thirty (30) days

    after the inspection is completed. The owner/operator must retain a copy.

    6. Detailed instructions on how to fill out this form are provided in the Department's “UST Inspector Reference

    Handbook”, available online at The Annual Inspection Report form,

    the Inspector Reference Handbook and a list of Frequently Asked Questions (FAQ’s) are also available by

    calling the Underground Tanks Unit at (207) 287-7688.

    To Installers and Inspectors: This electronic document (the overall workbook and each individual inspection

    worksheet) is password protected so that formulas and function in certain cells cannot be changed outside

    of the DEP. If you find errors in this workbook, need something clarified, have a suggestion on how to

    improve the form, or would like to include your business logo or make a similar addition to the form, please

    contact the DEP at 207-287-7688 and ask to speak with someone in the Underground Tanks Unit.

    Form Instructions

  • Underground Oil Storage Tanks

    Annual Inspection Report


    1 General instructions covering Annual Inspection requirements are located in the Annual Inspection Owner/Operator

    Guide , a separate document. Instructions for completing the Annual Inspection Report form are located in the UST

    Inspector Reference Handbook . The special instructions contained in this page are designed to be used in conjunction

    with, and to enhance the instructions of, the Handbook. These instructions will also provide a guide to functions that are

    specific to this Microsoft Excel workbook.

    2 This workbook contains all pages of the Annual Inspection Report form (Page 1: Summary through Page 9: Temporarily

    Out-of-Service Tanks ). It also contains two instruction pages and a copy of the Weekly Walkthrough Inspection

    Checklist. Each page is accessed by clicking on the color-coded tabs at the bottom of the workbook:

    = Form Instructions (two printed pages)

    = Guidance Document (for facility owners and/or operators)

    = Page 1: Summary

    = Pages 2-9: Inspection Checklist worksheets

    3 Information can only be entered into cells (blocks) that are NOT shaded.

    4 On all pages, blocks that are shaded light yellow cannot be filled in by the user. These shaded blocks are automatically

    filled in by the Excel program based on other entrees made in the form. For example: A CTI inspects a facility with only

    one tank and finds that the tank's ball float is not set at 90% tank capacity. The CTI then places an "X" in appropriate

    FAIL block (page 6, Item 41, cell block I15). The Excel program will then automatically place an "X" in the light-yellow

    "Overfill Prevention" FAIL box below Item 42 (cell block I17) and also place an "X" in the "Overfill Prevention" FAIL box

    for that tank on the Summary Page.

    5 Please use only the letter "X" when filling in any PASS, FAIL, Yes or No check-box. It doesn't matter if the "X" is

    capitalized or a small letter.


    6 Much of the information that a user enters on Page 1, Summary Page is automatically copied into appropriate cells

    (blocks) in the separate worksheet checklists. For example, the facility registration number and inspection date are

    copied and placed on the top of each subsequent inspection page. The tank/chamber number, volume, and product

    contained in a tank are also copied and pasted into pages where the information is needed.

    7 Each PASS block on the Summary page must be manually filled in (of course, this is only if the appropriate section in the

    inspection page warrants a PASS on the summary page!)


    8 An "X" that is placed in any "FAIL" box in an individual inspection page (pages 3 through 9) will automatically update the

    appropriate overall "FAIL" boxes in the Summary Page (page 1).

    9 "Pass" blocks must be manually filled-in, where appropriate, on each page; there is NO automatic copying of any "Pass"

    to the Summary Page (page 1)

    10 Use the key sequence: to start a new line in any "Comments" block; using just the key will close

    the editing session in the "Comments" block and move you to the next open fill-in block.

    11 If you need additional space for written comments, or in the case of page 6 where there is no comments section, use any

    other comments box on any page. Please start each comment with the inspection item number to which the comment


  • 1 2 3 4 5

    Date of Inspection:

    Release Detection:

    ● Is the Electronic system working properly?

    ● Is daily inventory being maintained and properly

    reconciled monthly?

    ● Is the Manual Groundwater or Tank Interstitial Space

    Log being maintained?

    Electronic Overfill Alarm (if equipped): Inspect/test for

    proper operation. Can a fuel delivery person hear and see

    the alarm when it alarms?

    Spill Log: Is the spill log properly used and maintained?

    Spill Buckets: Are spill buckets clean and empty?

    Spill And Overfill Response Supplies: Inventory the emergency spill response supplies. If the supplies are low,

    restock the supplies. Are supplies adequate?

    Fill And Monitoring Ports: Inspect all fill, monitoring and vapor recovery ports. Are covers and caps tightly sealed with no


    Dispenser Area: Check the dispenser islands and surrounding areas. Are these areas free of evidence of spills and discharges?

    Clean areas as needed.

    Dispensers And Dispenser Sumps: Open each dispenser

    cabinet and inspect all piping, fittings, and couplings for

    signs of leakage. Are the sumps free of any water, product

    or debris? (Remove any liquid or debris and disposed of


    Dispenser Hoses, Nozzles, and Breakaways: Are fittings tight and functioning properly? Are hoses in good condition (not

    cracked or showing any wear)?

    UST-28 REV: November 2017

    This checklist may be used by certified Class A/B Operators to perform weekly inspections at underground storage tank

    facilities. This checklist, when properly completed, will be accepted by the Maine Department of Environmental Protection

    as demonstrating compliance with the weekly inspection requirements of 06-096 C.M.R., Chapter 693, Operator

    Training for Underground Oil and Hazardous Substance Storage Facilities .

    You should be able to answer “yes” to each question. Your initials in each box below the inspection date indicates the

    device/system was inspected, is operating properly and is compliant with the requirements.

    On the back of this form, date and describe any actions taken to correct an issue.

    State of Maine

    Department of Environmental Protection

    Underground Oil Storage Facility - Class A/B Operator

    Weekly Walk-Through Inspection Checklist

    Month / Year: _______________________Facility Name & Reg # _______________________________

  • Maine Department of Environmental Protection 17 State House Station • Augusta, Maine • 04333-0017 • (207) 287-7688

    UST Program Website:

    Requirements for Unattended Fueling and Signage

    Requirements f

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